Itchy skin (pruritus) - Symptoms and causes

What is pruritus?

Pruritus is a medical term that means itching. It refers to a feeling or sensation on your skin that you want to scratch. Pruritus can be painful or irritating and could be localized to one area of your body or spread throughout several areas. An uncomfortable, irritating sensation that creates an urge to scratch that can involve any part of the body.

Common causes

Itching can have causes that aren't due to underlying disease. Examples include hair regrowth, sunburns, insect bites, dry skin or healing wounds.

For informational purposes only. Consult your local medical authority for advice.

Sources: College of Medicine, University of Ibadan and others

Pruritus can be a symptom of an underlying condition. It has many possible causes; the most common being contacting an allergen, dry skin, pregnancy and your body’s reaction to a medication. Pruritus can be chronic if your itching persists for six weeks or more.

What are the types of pruritus?

There are several different types of pruritus categorized by the cause of itchiness and the location of the itch on your body. Some of the most common types of pruritus include:

• Brachioradial pruritus: Itching of the upper arm caused by nerve damage.
• Nocturnal pruritus: Itching that occurs at night with several possible causes that include a reaction to your body’s natural functions, a reaction to a medication or contacting a skin irritant.
• Pruritus ani: Itching of the skin surrounding your anus caused by hemorrhoids, an infection or a skin irritant.
• Senile pruritus: Itching caused by changes to your skin that affects people over the age of 65.
• Uremic pruritus: Itching occurs as a symptom among people diagnosed with renal disease who receive dialysis.

Who does pruritus affect?

Pruritus is very common and will affect everyone during their lifetime. The severity and frequency are different for each person. You may be more at risk of pruritus if you:

• Are 65 years or older.
• Have allergies.
• Have an underlying condition like eczema, psoriasis or diabetes.
• Are pregnant.
• Are on dialysis.

What does pruritus feel like?

Pruritus causes your skin to feel itchy. This can be an uncomfortable or bothersome sensation that will only resolve if you scratch your skin. Sometimes, pruritus can be painful and other times, it could feel like something is tickling your skin. Scratching your itch can lead to more pain and irritation and won’t always resolve your itch. If your skin is frequently itchy, contact a healthcare provider.

Symptoms and Causes

What are the symptoms of pruritus?

The main symptom of pruritus is an itch. An itch is a feeling or uncomfortable sensation that causes you to scratch your skin to get relief. Scratching the itch doesn’t always provide relief.

If you scratch your itchy skin, you could have additional symptoms that include:

• Dry or cracked skin.
• Scratch marks (excoriations).
• Thick, leathery patch of skin (lichenification).
• Localized pain at the site of your itchy skin.
• Skin breaks open and bleeds.
• Broken skin leaks a yellow to white fluid, doesn’t heal or has a scaly or crusty texture (infection).

Additional symptoms of pruritus include:

• Skin discoloration that’s lighter or darker than the skin surrounding it.
• A rash forms on your skin that’s elevated or swollen (inflammation).
• Small pimple-like bumps on your skin (papules).
• Large bumps on the affected area of your skin.
• Blisters or fluid-filled bumps on your skin.

Sometimes, you could experience itchy skin along with additional symptoms like a rash or swollen skin. Other times, you’ll only experience itchy skin without other symptoms. Your provider will diagnose your condition and offer treatment options based on what caused your skin to itch.

What makes me want to itch my skin?

Pruritus symptoms cause you to feel itchy. Your immediate reaction is to scratch your skin. An outside stimulus usually triggers this itchy sensation. Outside stimuli could include something touching your skin, fibers in your clothing or moving your body naturally. Peripheral sensory neurons are nerve fibers in your nervous system that relay a message from your skin to your brain, and vice versa, to activate movement. When a stimulus triggers your body’s sensation to itch, your brain responds by telling you to scratch your skin.

What causes pruritus?

There are several causes of pruritus that include:

• Dermatologic: The itching is the result of inflammation or swelling within your body.
• Systemic: The itching is the result of an underlying medical condition that can affect your skin or your internal organs. This could include natural changes to your body with age or hormonal changes, among others.
• Neuropathic: Nervous system conditions or nerve damage causes itching.
• Psychogenic: Psychiatric conditions or conditions that affect your brain cause itching.
• Environmental: An irritant in your environment causes itching. This could be clothing material, an insect bite, a reaction to a drug, temperature or touching something uncomfortable.

The most common cause of pruritus is dry skin.

Is pruritus a sign of an underlying condition?

Several conditions have itching as a symptom. Some of the most common conditions that cause itching include:

• Diabetes.
• Liver or kidney disease.
• Pregnancy.
• Eczema.
• Psoriasis.
• Cholestasis.
• Obsessive-compulsive disorder.
• Allergies.
• Dermatitis.
• Thyroid disease.

Diagnosis and Tests

How is pruritus diagnosed?

To diagnose pruritus, your provider will physically examine your skin and will gather more information about your symptoms and your medical history. Your provider might ask you questions including:

• When did the itching start?
• Did you make any changes to your personal care products (soaps, lotions, etc.) before you started itching?
• Have you had other symptoms, such as weight loss, feeling very tired, night sweats or increased thirst?
• Did you start taking any new medications?
• Did you touch something specific, such as a plant or a new pet?

What tests diagnose pruritus?

Your provider might offer tests to confirm a diagnosis. Testing can help determine what caused your symptoms. Your itching might be the primary problem or it might be a symptom of another condition. Tests may include:

• Allergy tests to indicate if you’re reacting to something in your environment.
• Blood tests to reveal vitamin and mineral deficiencies or problems with your internal organs like your liver, kidneys or thyroid.
• Imaging tests (chest X-ray) to reveal conditions that extend beneath your skin, like cancer.
• Skin biopsy to identify skin conditions that cause itching. This test involves taking a small sample of skin and examining it under a microscope.

Management and Treatment

How do I get rid of pruritus?

Treatment for pruritus is unique to each person and varies based on what caused your symptoms. Treatment could include:

• Using a cream, lotion or ointment on your skin.
• Taking medicine to stop itching.
• Stopping or changing a medicine that causes symptoms. Don’t stop taking a medicine until your provider tells you it’s safe to do so.
• Treating or managing any underlying conditions that cause itching.
• Using nonmedical therapies to relieve itching like acupuncture, light therapy or transcutaneous electrical nerve stimulation therapy.

Are there at-home remedies to treat pruritus?

You can take steps to treat pruritus at home by:

• Regularly using creams and lotions to keep your skin moisturized and prevent dry skin.
• Wearing sunscreen to prevent sunburns and damage from the sun’s UV rays.
• Using unscented or sensitive skin products like detergent and soaps to avoid skin irritation.
• Taking a warm (not hot) bath or shower to relieve itchiness.
• Avoid wearing fabrics that cause skin irritation like wool and synthetic fabrics. Cotton clothing usually doesn’t cause skin irritation.
• Placing a cool washcloth or ice wrapped in a towel over the area of your skin that itches to calm your skin.

What medications treat pruritus?

Your provider may prescribe medications to treat pruritus, including:

• Antihistamines.
• Topical steroids or oral steroids.
• Immunosuppressant medications, such as cyclosporine A.

Some studies suggest that antidepressant medicines can offer relief to your itchy skin by relaxing the receptors in your body that cause itchiness.

What anti-itch creams treat pruritus?

To treat pruritus, your provider might recommend anti-itch creams to relieve your symptoms. You don’t need a prescription for some types of anti-itch creams and you can purchase them over-the-counter. Look for creams, lotions or ointments that are fragrance-free and contain at least one of the following ingredients to help relieve your itchy skin:

• Hydrocortisone: A drug that stops swelling and inflammation.
• Antihistamines: A drug that relieves symptoms from an allergic reaction.
• Capsaicin: A drug that treats minor aches and pain.
• Aloe vera: A substance extracted from a plant that soothes irritated skin.
• Menthol: A plant-based product that provides a cooling sensation when applied to your skin.
• Petroleum jelly: A mixture of mineral oils and waxes that provides moisture to your skin.

If your itchy skin persists or gets worse after using an anti-itch cream, contact your provider.

How soon after treatment will I feel better?

The length of time you’ll have pruritus depends on the cause of your itchy skin. Some diagnoses are long term and you’ll experience symptoms that come and go throughout your life. For others, your condition could be a temporary irritant that could go away within a couple of days. Talk to your provider about your diagnosis, the cause and how to treat your symptoms to help you feel better faster.

Prevention

How can I prevent pruritus?

While you can’t prevent all types of pruritus, you can take steps to reduce your risk of getting itchy skin by:

• Wearing sunscreen when you go outside or wearing UV-protective clothing and accessories.
• Drinking plenty of water.
• Moisturizing your skin daily or multiple times per day.
• Using warm (not hot) water when taking a shower or bath or washing your hands.
• Managing any chronic conditions you have.
• Using a humidifier in your home.
• Avoiding allergens.

Outlook / Prognosis

What can I expect if I have pruritus?

Pruritus will cause skin irritation and discomfort that can make it difficult for you to sleep. Severe cases can prevent you from completing normal activities because your itchy skin distracts you from the task at hand.

You can use at-home remedies like applying moisturizing cream or lotion to your skin regularly throughout the day. The most effective time to apply moisturizer is after a bath or a shower when your skin is slightly damp to lock in the moisture.

Sometimes, pruritus can be persistent (chronic) and last for more than six weeks or it can be a sign of an underlying condition. Talk to a healthcare provider about treatment options to relieve your symptoms.

How long does pruritus last?

Everyone’s body is different. You could experience relief from your itchy skin within hours after treatment or it could take several weeks. The length of time for your body to heal depends on what caused your symptoms. For a better time frame as to when your symptoms will go away, talk to a healthcare provider.

Living With

When should I see my healthcare provider?

Contact your healthcare provider if:

• You have itchiness that lasts longer than a couple of weeks.
• The itchiness interferes with your sleep.
• Treatment that your provider recommended makes your symptoms worse.
• Your skin is swollen and oozes pus, has a crusty texture and you have symptoms of nausea and vomiting and fever (infection).
• You develop new symptoms like weight loss or gain, changes to your body functions like bowel movements, fatigue or mood changes.

What questions should I ask my doctor?

• What types of lotions or creams should I use on my skin?
• Can I use over-the-counter anti-itch cream to treat my pruritus?
• What caused my itchy skin?
• How often should I apply anti-itch cream or the treatment you recommend?

Additional Common Questions

What is the difference between itching and pruritus?

Pruritus is the medical term for itching. There’s no difference, as both terms refer to the same symptom.

What’s the difference between pruritus and urticaria?

Pruritus is itchy skin that could have many different causes. Urticaria is a skin condition that causes hives and a stinging, tickling or burning sensation in areas of your skin. A symptom of urticaria is pruritus.

While your brain is telling your body to scratch your itchy skin, try your best to avoid scratching. When you scratch your skin, you could break it open and create a wound that can easily become infected. Treat your itchy skin at home by using moisturizer, anti-itch creams, applying a cold compress or taking a warm bath. Contact your provider if your itchy skin doesn’t go away after a couple of weeks or gets worse with treatment.